MEDICARE: DR. MELINDA D JOHNSON O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1565-597T	LA
2	152W00000X	Optometrist	7356T	TX

General Provider Information

NPI Number	:	1063678704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELINDA D JOHNSON O.D.

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1914
Country	:	US
Telephone Number	:	817-738-2027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	04/14/2025

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